| NPI | 1184992851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A126340) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX R0292) |
| 208600000X Surgery (Licence: FL ME158300) | |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2024-05-08 |